Pediatric Osteosarcoma Clinical Presentation

Updated: Jan 05, 2021
  • Author: Timothy P Cripe, MD, PhD, FAAP; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Those affected by osteosarcoma often describe symptoms that begin weeks, months, or occasionally longer before being diagnosed. The most common presenting symptom is pain, particularly with activity. Patients often describe symptoms that suggest a sprain, arthritis, or "growing pains." They often identify a history of trauma as a trigger when the pains begin, although pathologic fractures are not particularly common (the exception being the telangiectatic subtype of osteosarcoma, which is commonly associated with pathologic fractures). If pain affects a lower extremity, patients often walk with a limp.

The lesion may cause swelling, depending on the size and location. Systemic symptoms, such as fever and night sweats, are rare. While 15-20% of patients initially present with lung metastasis, these rarely cause respiratory symptoms.  Breathing symptoms usually indicate extensive lung involvement. Metastases to other sites are extremely rare, making other symptoms uncommon. 

Osteosarcoma most commonly involves the distal femur and proximal tibia, followed by the proximal humerus and mid and proximal femur. As many as 20% of patients present with tumors of the flat bones of the body including the skull and pelvis. Tumors of the jaw are relatively uncommon.


Physical Examination

Physical findings are usually limited to those of the primary tumor site.

  • Mass: A palpable mass may be present. The mass may be tender and warm, although these signs are indistinguishable from those of osteomyelitis. Increased skin vascularity over the mass may be discernible. Pulsations or a bruit may be detectable.

  • Decreased range of motion: Joint involvement should be obvious on physical examination.

  • Lymphadenopathy: Involvement of local or regional lymph nodes is unusual.

  • Respiratory findings: Auscultation is usually uninformative unless extensive pulmonary disease is present.